Abstract Carotid web (CaW) is a nonatherosclerotic vascular anomaly and an underdiagnosed cause of embolic ischemic stroke, particularly in young patients without traditional vascular risk factors. Its intraluminal position and morphology produce local hemodynamic disturbances that promote thrombus formation and account for the high rate of recurrent distal embolism reported with medical therapy alone. Accurate diagnosis relies on careful evaluation with computed tomography angiography and multiplanar reconstructions, as CaW may be overlooked on conventional imaging. Current evidence indicates that, in symptomatic patients, antithrombotic therapy alone is insufficient to prevent early recurrence, whereas carotid revascularization with endarterectomy or stenting provides excellent safety and efficacy. In contrast, optimal management of asymptomatic CaW remains uncertain and is generally based on clinical and imaging surveillance. This review summarizes the diagnostic features, natural history, and treatment strategies of CaW and presents a practical algorithm to support clinical decision-making in neurovascular practice.
Abstract Idiopathic intracranial hypertension (IIH) is a potentially sight-threatening condition characterized by elevated intracranial pressure without an identifiable cause. This case highlights the importance of appropriate surgical selection in a patient with IIH and progressive visual deterioration. Given the patient's severely compromised optic nerves, ongoing visual loss, and intolerance to medical therapy, urgent intervention was required to decompress the intracranial venous system. The most effective options in such cases include venous sinus stenting or cerebrospinal fluid (CSF) diversion via shunting. In this patient, venous sinus stenting was not a viable option; therefore, CSF diversion through shunt placement was pursued.
Abstract Spine surgery has evolved from manual, highly variable procedures to standardized, reproducible approaches with advancements in robotic-assisted spine surgery (RSS). As these technologies are developed further, procedural complexity may increase along with safety and efficacy profiles. This article provides an updated overview of the landscape of robotic-assisted spine surgery, including clinical applications, technological developments, reported benefits, limitations, and future directions for integration into modern spine practice.
Abstract Metastatic pituitary neuroendocrine tumors (PitNETs), formerly known as pituitary carcinomas, represent a rare subset of pituitary neoplasms, accounting for approximately 0.1% to 0.2% of cases. These tumors typically arise from pre-existing functional macroadenomas and most commonly metastasize to the liver, bone, lungs, and throughout the central nervous system. Given that there are no specific clinical, histopathological, or imaging features that can reliably distinguish metastatic PitNETs from benign or aggressive pituitary adenomas at early stages, timely diagnosis remains challenging. Multidisciplinary management is essential, with therapeutic strategies including repeat surgical resection, radiotherapy, and systemic therapy with temozolomide, either as monotherapy or as part of the Stupp protocol. Emerging therapeutic options, such as peptide receptor radionuclide therapy and immune checkpoint inhibitors, have also shown encouraging results in selected refractory cases. Despite multimodal treatment approaches, sustained responses are uncommon, and the prognosis remains poor, with a mean survival of approximately 2 years following the detection of metastases. Given their rapid progression and unfavorable outcomes, early recognition of metastatic PitNETs is critical. Neurosurgeons should be particularly vigilant in patients with rapidly recurring, hormonally active, and treatment-refractory macroadenomas, as these features may indicate an increased risk of metastatic transformation and warrant closer surveillance. This article reviews the initial clinical presentations, imaging and histopathological characteristics, prognosis, and current management strategies for metastatic PitNETs.
Abstract Noninvasive brain stimulation (NIBS) techniques, including transcranial magnetic stimulation (TMS), transcranial direct and alternating current stimulation (tDCS, tACS), and transcutaneous vagus nerve stimulation (tVNS), represent promising tools for neurorehabilitation and symptom management across neurological and psychiatric conditions. These modalities modulate cortical excitability, foster neuroplasticity, and target maladaptive network activity. Evidence supports applications in stroke, Parkinson disease (PD), Alzheimer disease, chronic pain, and psychiatric disorders, though methodological variability, heterogeneous patient populations, and lack of standardization limit clinical translation. This review synthesizes current knowledge, highlights therapeutic potential, and underscores the need for rigorous trials to establish efficacy and optimize treatment protocols.
